Supervision Interest Form

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This form is designed for individuals interested in applying to become a Licensed Clinical Mental Health Counselor Associate (LCMHCA) in the state of North Carolina. Supervision services will officially begin in January 2025.

This service is ideal for candidates working part-time (30 hours or less per week) in a clinical or private practice setting. Please note that 1 hour of supervision is required for every 40 hours of combined direct and indirect services provided.

We look forward to supporting you on your journey toward licensure!

Full Name *

Preferred Name

Pronouns

Email for Contact *

Telephone Number *

Which of the following best describes your licensure status? *

I am a graduate student who is expected to graduate in 2025 or later.

I have completed graduate school and plan to submit the application for LCMHCA in 2025 or later and need a supervisor.

I have an active LCMHCA license, I work in the field of counseling part-time and will need a new supervisor in 2025.

I am a school counselor who would like to apply for the LCMHCA and need a supervisor for the hours that I will work in the school setting.

Other:

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